Time and Financial Costs for Physician Practices to Participate in the Medicare Merit-based Incentive Payment System

Abstract

IMPORTANCE The Merit-based Incentive Payment System (MIPS) is a major Medicare value-based purchasing program, influencing payment for more than 1 million clinicians annually. There is a growing concern that MIPS increases administrative burden, and little is known about what it costs physician practices to participate in the program. OBJECTIVE To examine the costs for independent physician practices to participate in MIPS in 2019. DESIGN, SETTING, AND PARTICIPANTS This qualitative study identified and interviewed leaders of physician practices participating in the US Centers for Medicare & Medicaid Services (CMS) MIPS program, including those in MIPS alternative payment models. Time required and financial costs were calculated from responses to in-depth, semistructured interviews conducted from December 12, 2019, to June 23, 2020. Physician practices were categorized by size (small, 1-9 physicians; medium, 10-25; and large, Ն50), specialty (primary care, general surgery, or multispecialty), and US census region. Participants were asked about 2019 costs related to clinician and staff time, information technology, and external vendors. Time was converted to financial costs using the Medical Group Management Association's Provider Compensation and the Management and Staff Compensation databases. MAIN OUTCOMES AND MEASURES Annual time spent by staff on MIPS-related activities and mean per-physician costs to physician practices in 2019. RESULTS Leaders of 30 physician practices (9 [30.0%] small primary care, 6 [20.0%] small general surgery, 4 [13.3%] medium primary care, 4 [13.3%] medium general surgery, and 7 [23.3%] large multispecialty) represented all US census regions, and 14 of the 30 (46.7%) practices participated in a MIPS alternative payment model in 2019. The mean per-physician cost to practices of participating

Merit‐based incentive payment system participation and after‐hours documentation among US office‐based physicians: Findings from the 2021 National Electronic Health Records Survey

“…Healthcare administrators have reported a substantial amount of resources was spent to meet the administrative needs imposed by the MIPS programme. 14,17 Our study adds to these findings that MIPS participation may also impose after-hours documentation burden among physicians. Put together, these findings suggest that the design of a given programme and its reporting requirements may have implications for documentation burden among ambulatory physicians.…”

“…Our findings suggest that participation in the MIPS programme was associated with increased odds of reporting greater amounts of after‐hours documentation. Healthcare administrators have reported a substantial amount of resources was spent to meet the administrative needs imposed by the MIPS programme 14,17 . Our study adds to these findings that MIPS participation may also impose after‐hours documentation burden among physicians.…”

“…Although this reporting improves accountability and transparency of care delivery, 3 several studies suggest that reporting data for quality measures for several pay‐for‐performance programmes may impose an administrative burden on clinicians 4–14 . While the MIPS has been criticized for its extensive reporting requirements, 15,16 limited studies have been conducted on how MIPS participation has affected physicians’ administrative burden 17 . High amounts of administrative and documentation burden can manifest themselves as after‐hours documentation when there is insufficient time in the workday to complete them.…”

“…[4][5][6][7][8][9][10][11][12][13][14] While the MIPS has been criticized for its extensive reporting requirements, 15,16 limited studies have been conducted on how MIPS participation has affected physicians' administrative burden. 17 High amounts of administrative and documentation burden can manifest themselves as after-hours documentation when there is insufficient time in the workday to complete them. Unfortunately, this uncompensated work has been associated with burnout, 18 which can lead to turnover.…”

Using Consistently Low Performance to Identify Low-Quality Physician Groups

“…In addition, the burden of quality measurement on physicians and the substantial investments made in measurement development have been a continuous concern. [1][2][3][4] In the US, physician practices spend more than $15.4 billion annually on reporting quality measures alone. 4 With health care expenditures rising, it is increasingly critical that resources for tracking quality are used effectively.…”